Healthcare Provider Details

I. General information

NPI: 1174820971
Provider Name (Legal Business Name): WATAUGA PATHOLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W MARKET ST
JOHNSON CITY TN
37604-6020
US

IV. Provider business mailing address

1725 W MARKET ST
JOHNSON CITY TN
37604-6020
US

V. Phone/Fax

Practice location:
  • Phone: 423-431-1310
  • Fax: 423-431-6331
Mailing address:
  • Phone: 423-431-1310
  • Fax: 423-431-6331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateTN

VIII. Authorized Official

Name: DR. DAVID SOIKE
Title or Position: PRESIDENT
Credential: MD
Phone: 423-431-1310